Reporting - Medical Records Retrieval Specialist

Medical Records Retrieval Specialist

The Medical Records Retrieval Specialist is responsible for requesting, collecting, organizing, and processing medical records to support Risk Adjustment, HEDIS, and Quality Improvement initiatives. This role manages all outbound and inbound record requests, retrieves documentation from provider offices and EMR/EHR systems, and ensures accurate, timely, and compliant handling of sensitive health information. The specialist works closely with the Risk Adjustment Supervisor and collaborates with provider groups through fax, phone, and occasional on-site visits. This position is office based with some travel required.

Key responsibilities include submitting, tracking, and following up on medical record requests. Ensuring the medical records are organized, accurate, and complete. Maintaining compliance with record retention and destruction policies. Retrieving records from EMR/EHR systems such as EPIC, Cerner, and other provider platforms. Scanning, uploading, and processing inbound records received via fax, mail room, or electronic systems. Supporting Risk Adjustment/RADV Audits, HEDIS, and Quality Improvement record collection projects. Tracking, abstracting, and organizing member health records during audit seasons. Assisting with ad hoc audit requests and special retrieval projects. Creating, maintaining, and updating a centralized provider repository containing contact details, access instructions, retrieval notes, and historical performance. Communicating with provider groups regarding record requests, status updates, and follow ups. Updating provider contact information (fax numbers, phone numbers) as needed. Maintaining clear documentation of all retrieval activities in chase reports. Notifying the supervisor of any issues or delays affecting record retrieval. Meeting daily and weekly productivity goals set by the supervisor. Developing process workflows, escalation pathways, and standardized call scripts to support efficient and consistent operations. Performing other job-related duties as assigned.

Qualifications include effective communication and collaboration abilities. Excellent problem-solving and critical thinking skills. Strong attention to detail and organizational skills. Ability to maintain confidentiality and handle sensitive information. Ability to maintain records and comply with retention policies. Proficiency with Microsoft Office and Adobe PDF. Successful completion of Health Care Sanctions background check.

Education/experience includes a high school diploma or 2+ years of experience in a similar role. Medical office experience preferred. Risk adjustment & HEDIS experience preferred. Basic knowledge of EMR/EHR systems with ability to learn new software quickly.

CommunityCare is an equal opportunity at will employer and does not discriminate against any employee or applicant for employment because of age, race, religion, color, disability, sex, sexual orientation or national origin.